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Surgery > Kaplan Questions > Flashcards

Kaplan Questions Flashcards

1
Q

What to worry about when a child has a supracondylar fracture?

A

vascular and/or nerve injury, specifically brachial artery and/or median nerve. Also, must have close followup immediately after the fracture has been reduced and immobilized to ensure that growth stunting does not occur from growth plate injury

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2
Q

How to manage wound dehiscence?

A

conservatively by taping the wound, maintaining a moist environment, reducing the pain, and promoting granulation tissue.

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3
Q

lumpectomy vs masectomy: generally, how big is the malignant mass?

A

any malignant mass > 4 cm in diameter exceeds the criteria to perform a lumpectomy.

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4
Q

Post-op ileus often occurs after surgery, especially abdominal ones. How to manage? And which electrolyte abnormality can worsen post-op ileus?

A
  • NPO and NG tube

- hypokalemia can worsen post-op ileus

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5
Q

acute prostatitis presents with LBP, fever, perineal pain, and irritative urinary symptoms. PE reveals a warm exquisitely tender prostate. What are the abx of choice and for how long do you treat?

A

fluoroquinolones and treat for 4-6 wks.

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6
Q

Epididymitis is most likely caused by c. trachomatis that can manifest as unilateral intrascrotal pain, swelling, and fever. What is the Prehn’s sign?

A

When lifting the testes relieves the pain.

Treatment is doxycycline, tetracycline or azithromycin

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7
Q

Congenital hip dislocation -> what may you find on PE? What imaging to do if PE doesn’t support the dx but there’s high clinical suspicion

A

joint instability subluxation or dislocation of hip w/ passive manipulation. A distinct clicking sound can be heard with motion of abducted legs. Can confirm with ULTRASOUND. Treatment is pavlik harness with splinting in an ABDUCTED fashion for approx 6 mo.

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8
Q

What is part of reynold’s pentad? What is it a sign of? How to manage?

A

Ascending cholangitis
a combination of Charcot’s triad (RUQ pain, jaundice, and fever) + shock + AMS

Key to management is immediate decompression of common bile duct which is full of pus. First choice is via ERCP, but can also be done by percutaneous transhepatic cholangiography or by open surgery

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9
Q

What are typical signs of strangulated hernia which is a surgical emergency? Which type of symptom makes us consider a strangulated hernia until proven otherwise.

A

Any sudden pain or new irreducibility of a long-standing hernia should be considered strangulated until proven otherwise.

Typical signs: abd pain, fever, a mechanical ileus (entrapped bowel), and leukocytosis.

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10
Q

Thyroglossal duct cyst is the most common congenital cystic midline neck mass. They can become infected and become renlarged and tender. but are otherwise generally nontender and asymptomatic. HOw to diagnose? Manage?

A

Diagnosis is clinical -ask pt to swallow and document if the cyst is mobile, not fixed.Treatment is surgical excision called sistrunk procedurein which the cyst, middle third of hyoid bone, and thyroglossal duct tract are all excised.

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11
Q

What is the diagnostic test of choice for nephrolithiasis (increased in ppl with hyperparathyroidism, crohns)?

A

CT without IV contrast

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12
Q

Gastric dumping syndrome aka rapid gastric emptying happens when the small intestine fills too quickly with undigested food from the stomach. Can be seen in pts with gastrectomy and antrectomy. what are some symptoms

A

N/V, bloating, cramping, diarrhea, dizziness, fatigue, weakness, sweatng and hypoglycemia aka alimentary hypoglycemia when rapid dumping of food triggers release of excessive amts of insulin

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13
Q

What is the most accurate test for chronic pancreatitis?

A

secretin stimulation test with great specificity that directly measures pancreatic function. A healthy person should release a large volume of bicarb-rich pancreatic fluid in response to IV injection of secretin. A person who has chronic pancreatitis will not do so.

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14
Q

What’s the study of choice to detect a colovesical fistula

A

CT with contrast bc the most common site for fistula is the sigmoid colon and the most common cause is diverticulitis. The CT can show inflammatory diverticular mass.

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15
Q

What’s the favored study to evaluate for small bowel obstruction? What about this study that makes it not only good for diagnostic purposes?

A

CT scan with gastrograffin. Gastrograffin has an osmotic effect on the small bowel which can lead to a potential resolution of obstruction.

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16
Q

Nitrates and sildenafil should not be prescrbed together b/c it can lead to precipitous drop in BP. Whats 2nd line choice for someone with erectile dysfunction?

A

vacuum device (contraindicated in ppl on anticoagulation, firbosis of penis, bleeding disorders)

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17
Q

Someone with cushing-like symptoms with high cortisol and high ACTH. How to differentiate this from ectopic-ACTH production by a small cell lung cancer vs pituitary adenoma

A

HIGH dose dexamethasone can suppress some of the cortisol production if pt has pituitary adenoma, but no suppression of cortisol if it’s ectopically produced

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18
Q

Indications for tagged RBC study in evaluating GI bleeding

A

When someone comes in with GI bleeding, colonoscopy and barium enema are contraindicated in acute setting. Endoscopy is done to rule out upper GI source. But if NG tube is placed and is draining bile and no blood, then endoscopy isn’t necessary. A tagged RBC scan can be done if bleeding is btw 0.5 ml - 2 ml/min of bleeding. If > 2 ml/min, then an angiogram is indicated.

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19
Q

Unless IV fluids are administered (dilutional effect), what does getting CBC show in acute blood loss

A

no change b/c takes about 6+ hrs for hb/hct to reflect change

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20
Q

Follicular carcinoma of the thyroid gland -management?

A

total thyroidectomy and post op radioactive iodine. Radioactive iodine is indicated to destroy remaining malignant cells and the normal functioning cells in thyroid gland. Total thyroidectomy b/c any presence of normal thyroid tissue can compete against malignant cells for uptake of radioactive iodine.

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21
Q

What to suspect if pt loses sensation in lower chin and aw?

A

mandibular fracture distal to the entrance of inferior alveolar nerve that passes thru the mandibular foramen and exits both laterally and anteriorly to innervate the lower chin and jaw

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22
Q

Displaced fracture bones need what type of surgery vs nondisplaced

A

displaced –> open reduction and internal fixation
nondisplaced –> closed reduction and casting

*if swelling –> postpone surgery until swelling subsides

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23
Q

What’s the modality of choice to diagnose avascular necrosis early on?

A

MRI

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24
Q

What’s the treatment for severe hypothyroidism?

A

steroids to address potential adrenal insufficiency bc pts who develop severe hypothyroidism commonly develops it 2/2 to a stressor such as surgery so steroids before levothyroxine helps

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25
Q

Grey Turner sign

A

bruising along the flanks caused by subcutaneous tracking of digested blood along the abdomen from the inflamed pancreas.

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26
Q

When to suspect pancreatic abscess? What to do

A

10-14 d after acute pancreatitis when pt gets high-grade fever and leukocytosis. Get CT scan of abdomen followed by drainage.

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27
Q

Trauma can lead to AV fistulas, classically presenting with a bruit, palpable thrill, and tacyh. In longstanding cases, it could lead to venous HTN –> edema. Most commonly involved areas are.

A

groin, limbs and neck vessels

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28
Q

Thoracic outlet syndrome (TOS) could be caused by a # of etiologies: arterial, venous, nerves. What’s the manifestation of a venous TOS

A

venous engorgement, edema

can be due to hypertrophy of scalene muscles compressing on the veins

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29
Q

SIADH can be caused by any change in CNS like infection, stroke, trauma, tumor. Pt will have hyponatremia, hypo-osmolality, and an increased urine osmolarity. How to treat

A
  • fluid restriction and diuresis with loops

- If these initial measures don’t work, can use ADH antagnoists like demeclocycline or lithium

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30
Q

Acute epididymitis regardless of etiology should be treated how??

A

abx, scrotal support (elevation) in combo with bed rest, and local use of ice pakcs, scrotal elevaton analgesics

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31
Q

What is the pringle maneuver

A

consists of clamping the portal triad in the hepatoduodenal ligament which will control inflow to the liver from hepatic arteries and the portal vein and common bile duct

32
Q

Ischemic colitis is a well recognized complication of AAA repair, open or endovascular. Usu b/c IMA is covered by aortic graft and pts who do not have adequate collateralization via the marginal artery of drummund from the SMA –> ischemia of sigmoid colon.

What symptoms are diagnostic of this condition? What’s gold std to diagnose? How to treat?

A

post-op bloody diarrhea and leukocytosis are essentially diagnostic of this condition

gold std: colonoscopy or flexible sigmoidoscopy

Treat with colonic resection with colostomy

33
Q

Problem with wrist extension –> wrong with which nerve

A

radial

34
Q

Lifesaving massive fluid infusion may produce severe edema of abd contents. forced closure will increase the intra-abd pressure, compressing the lungs (hypoxia) and IVC (renal failure). How to avoid abdominal compartment syndrome?

A

temporary plastic coverage or absorbable mesh should be placed to allow closure of wound

35
Q

What’s a morton neuroma?

A

enlarged nerve located in the foot’s third interspace btw the 3rd and 4th toes. DX is made by eliciting pain on palpation of that area.

36
Q

What’s the first step in managing confused pts post-op

A

give oxygen via NC bc unless otherwise specified, hypoxia should be considered as first cause of postop confusion. Treat with NC oxygen until cause is determined

37
Q

Colonic pseudo-obstruction or Ogilive syndrome is characterized by abd pain, distension, nausea, constipation and a dilated large bowel typically in post-op period. How to manage?

A

medically with IV neostigmine 2mg slowly

in the past colonoscopy with placement of rectal tube was way to go.

38
Q

A high spinal anesthetic can produce vasomotor shock bu inducing widespread vasodilation by sympathetic blockade. What’s the therapy of choice.

A

vasoconstrictors
and fluids

neurogenic shock is similar to septic shock in that in both presentations, pt will be flushing, warm, with decreased SVR, increased CO

39
Q

Suspect cardiogenic shock when theres decreased CO and increased SVR. What’s the drug of choice to manage cardiogenic shock in that it increases contractility and output but may worsen tachy.

A

dobutamine (potent b-agonist)

40
Q

Anterior dislocation of the shoulder is the most common dislocation. How does the pt usu present? What’s the nerve that’s involved?

A

Pt usu presents with the arm held close to the body and the forearm rotated outward as if preparing to shake hands.

Axillary nerve injury is a common complication

41
Q

Posterior dislocation is not as common as anterior dislocation of the shoulder. Pt often has a more normal protective position, close to the body. What can cause posterior dislocation

A

massive uncoordinated muscle contractions seen in electrical injuries, epileptic seizures

42
Q

Acute bacterial prostatitis are most often caused by e. coli or chlamydial infection. What’s the abx of choice and for how long?

A

fluoroquinolones is a good empiric choice for 4-6 wks b/c need adequate drug levels to penetrate prostatic tissue.

43
Q

Which malignant tumor has this unique presentation in which once removed can give metastasis 20 years later. Classic picture is a patient who has metastasis and a missing toe or a glass eye or liver mets. What’s the tumor marker you can monitor

A

metastatic melanoma

tumor marker: tyrosinase

44
Q

How does estrogen-progestin therapy be beneficial in postmenopausal women who have primary hyperparathyroidism?

A

can reduce bone resorption thereby increasing bone density and decreasing serum calcium concentrations

45
Q

Old ppl when they fall on outstretched hand can get colle’s fracture. On exam, there’s dorsal angulation giving it an appearance of a dinner fork on x-ray. What’s the treatment?

A

treatment includes closed reduction of the fracture and long or short arm cast immobilization depending on the degree of displacement and instability of the fracture

46
Q

Splenic vein thrombosis is a rare complication of pancreatitis. Why does that occur? What’s treatment?

A

bc splenic vein runs on the posterior surface of the pancreas, adjacent inflammation can induce thrombosis. Clue is presence of isolated gastric varices without any concomitant esophageal varcies. Treatment is splenectomy

47
Q

Bladder cancer presents with painless hematuria that may cause irritative symptoms such as dysuria, urgency and frequency. What’s the best dx?

A

cystoscopy allows visualization of the mass and possibility of obtaining a biopsy specimen

48
Q

How to manage an uncomplicated cystic mass in the epididymis found by scrotal ultrasound?

A

usu asymptomatic and needs no further workup or treatment

49
Q

Painless masses in the neck in an older pt are considered cancer until proven otherwise. Most of them are? Whats the work up?

A

squamous cell carcinomas arising from respiratory or digestive tract

Work up includes direct visualization of oropharynx with panendoscopy, FNA, and imaging with CT and/or MRI

50
Q

What are ways to decrease increased intracranial pressure?

A
  • raising the head of the bead
  • sedation
  • MV
  • hyperventilation
  • administration of mannitol
  • surgical decompression w/ a burr hole or craniotomy
51
Q

ampulla of vater is

A

hepatopancreatic ampulla aka hepatopancreatic duct formed by the union of the pancreatic duct and the common bile duct, specifically located at the major duodenal papilla

52
Q

Every ____ that serum sodium concentration is greater than normal = approx 1 L of water deficit

A

3 mEq/L

53
Q

Anal fissures present with extreme pain and bright red bleeding with defecation as well as pain with sitting or valsalva. On exam, 90% of fissures are seen at?

A

posterior midline, distal to dentate line

54
Q

Direct inguinal hernias make up a quarter of hernias. Where do you feel the hernia on examination?

A

on examination, the hernia is felt along the lateral aspect of the examiners finger when the finger is placed in the external inguinal ring. The defect is in the posterior wall of the inguinal canal

55
Q

A defect in the deep inguinal ring produces what type of hernia?

A

indirect inguinal hernia when herniation of the gut thru the internal ring of the inguinal canal. lateral to inferior epigastric vessels

56
Q

Asymptomatic bacteruria (org > 100,000) should be treated in pregnant patients, immunocompromised, and pts on chronic steroid therapy or post-transplant patients.. Which abx is good to use in pregnant patients? What are teratogenic?

A

nitrofurantoin is fine during preg so are amoxicillin, augmentin, cephalosporin, fosfomycin

bactrim, quinolones, doxy are teratogenic

57
Q

Rhinocerebral mucormycosis is a devastating fungal infection that is seen in debilitated and diabetic patients. Biopsy specimen will show thrombosed vessels and multiple broad nonseptate hyphae with right-angle branches. Whats the treatment

A

amphotericin B and surgical debridement

58
Q

What to do with someone with cholecystitis but has recent MI?

A

elective surgery is contraindicated. so will do percutaneous cholecystostomy and in 6-8 wks do lap cholecystectomy

59
Q

In liver transplantation, what’s the most common cause of early functional deterioration and have to be excluded first before doing liver biopsies to look for organ rejection

A

tehcnical problems with biliary and vascular anastomoses that can be evaulated with ultrasound of the biliary tract and doppler studdies of the anastomosed vessels.

60
Q

Chance of wound infection can be predicted based on the wound’s classification of contamination. List the 4 different types of wound and the associated risk

A

Class 1: clean wound 1-1.5%
Class 2: clean-contaminated wound: 3-5%
Class 3: contaminated wound: 10-15%
Class 4: dirty wound: 30-35%

61
Q

In most cases, displaced fractured bones need?

A

open reduction and internal fixation

62
Q

When are 5a reductase inhibitors indicated in treatment of BPH since alpha blockers (tamsolusin) are first-line?

A
  • when BPH symptoms don’t resolve with alpha blockers, finasteride can be added
  • when prostate is huge > 40 g
63
Q

What are conditions that can induce toxic megacolon in someone with UC? How to treat?

A

-hypokalemia, opiates, anti-cholinergics, loperamide, barium enema

can treat conservatively with 24-48 hours of IV fluids, IV steroids, abx, IV cyclosporine

If it does not resolve, then can do total colectomy

64
Q

Cancer of the head of the pancreas generally presents with painless obstructive jaundice. Obstructive jaundice is evident by high alk phosp, dilated biliary ducts. Malignancy is suggested by the dilated, think-walled gallbladder without stones. Whats a good imaging study to do with high sensitivity to detect cancer?

A

CT scan has a high sensitivity

65
Q

Define a clean contaminated wound

A

one that is created in a sterile environment but involves entry into the respiratory, GI, or genital systems or the urinary tract, but with no or limited spillage from that system. Risk of wound infection is 3-5%

66
Q

What’s a clean wound?

A

created in a sterile, nontraumatic setting and do not involve respiratory, GI or genital symstems. Risk of infection is 1-1.5%

67
Q

Describe a contaminated wound

A

gross spillage from one of the systems (GI, resp, GU), a wound that is a result of recent trauma or an outright violation of sterile technique in the OR with a 10-15% chance of wound infection

68
Q

Describe a dirty wound

A

result of trauma that contains devitalized tissue or is in the presence of established infection with a 30-35% chance of wound infection

69
Q

In cases of suspected skin cancer, a biopsy specimen where can provide the most info to the pathologist for dx and staging?

A

a biopsy specimen at the edge of the lesion provides the most impt info to the pathologist for dx and staging

70
Q

The chances of femoral head surviving a displaced neck fracture are slim 2/2 to tenuous blood supply and development of avascular necrosis. Much quicker recovery can be expected if?

A

native bone is discarded and a prosthesis is put in place.

71
Q

What imaging scan can best confirm pheo?

A

MRI

72
Q

Which testicular cancer has the most undifferentiated form of germ cell tumor and histologically appears like sheets of undiff cells with scant cytoplasm, indistinct cell borders, crowded nuclei, numerous mitoses, and necrosis. It shows aggressive biologic behavior with early met and elevated serum AFP.

A

embryonal carcinoma

73
Q

General rule for vascular surgical workup of peripheral artery disease

A
  • ABI index
  • pulse volume recording (PVRs): doppler US of the flow at each arterial level during ABI assessment, which will generate a flow diagram that can be compared with normal flow patterns and the level of stenosis
  • then gold std of angiogram to identify stenosis, requires passing needle thru fem artery then injecting contrast and performing real-time fluoroscopy

*CT-A is less invasive than gold std of angiogram so sometimes CTA or MRA can precede that

74
Q

What is reflex sympathetic dystrophy aka causalgia

A

intense burning pain that occurs after an injury.

pain management w/ local anesthetics or surgical sympathectomy is usu needed

75
Q

Constipation in neonate should be considered hirschsprung until proven otherwise. What to perform initially?

A

barium enema

76
Q

Pneumobilia supports the presence of?

A

a fistula btw the biliary tract and the bowel

77
Q

What is emphysematous cholecystitis?

A

air within the gallbladder wall itself and is seen in very sick ppl who have multiple comorbidities

Surgery (6 decks)

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